In Geneva today, the World Health Assembly — that is, the annual meeting of the 194 governments whose collective commitment support the World Health Organization — opened as traditional, with a speech by the WHO’s director-general, Dr. Margaret Chan. It is a very interesting time, not just for the WHA to be meeting, but for Dr. Chan to be addressing them. That’s because, 10 years ago when SARS exploded into the world from China, she was the director of health for Hong Kong, the city that was hit first and hardest. Ten years later, with H7N9 flu emerging from China, and a viral relative of SARS — the novel coronavirus now being dubbed MERS — bubbling in the Middle East, the questions and lessons of SARS are bizarrely resonant. That has been true for the past several weeks, but is even more so today, with one more case of MERS announced, in one more country: Tunisia, this time.

Here are the opening paragraphs from Chan’s speech (full text online here). To me it’s quite interesting how much she praises China for its transparency in dealing with H7N9 flu — while not extending the same praise to the Kingdom of Saudi Arabia, where MERS is concentrated. In fact, she doesn’t even mention Saudi Arabia by name; whether that is meant to give offense, or to avoid it, other public-health tea-leaf readers can say better than me. Though her closing comment — “the current situation demands collaboration and cooperation from the entire world” — sounds pretty pointed to me.

My last twoposts looked at the problems that might be caused by hospital spread of the new coronavirus, based on what happened during the early days of SARS 10 years ago. Hospital spread of this new virus is a real concern; it was first identified, retrospectively, in an outbreak in a hospital in Jordan a year ago, and international concern really picked up after the acknowledgement of a current outbreak in the Al-Ahsa region of Saudi Arabia. Now it appears there is a third instance of hospital spread, in France. Several days ago the French Ministry of Health announced a single case, a Frenchman who had traveled to Dubai and may have been infected there. This morning, there is news of a second case, a person who shared a hospital room with the first patient. Here’s the announcement from the French Ministry and one from the World Health Organization. (And if you read French, I talk to the French newspaper Le Figaro about it here.) Simultaneously, the WHO has announced that two more patients have been recognized in that Saudi hospital cluster. That makes 15 patients (three of whom died) in that cluster, and 34 patients (18 deaths) worldwide.

There’s additional news today as well, which is both heartening and a little concerning too.

In my last post 36 hours ago, I raised questions about Saudi Arabia’s apparent delay in reporting new cases of the novel coronavirus that has been causing low-level unease since last summer. (For the full history of that, check these posts.) So it’s only fair to say that, within 24 hours, the Saudi government behaved very differently with a new report.

The bad news is, the new report is about yet more cases of the novel virus. But the good news is, the report of the new cases was quickly shared internationally, by the government’s Deputy Minister for Public Health, via the international disease-alert mailing news ProMED.

I’m still catching up on all the news that happened during the weeks I was away, and I had a food-policy post just about set to go today. And then this happened.

I opened my morning mail to find a note from a private list I subscribe to, published by a company that monitors hazards for businesses with expatriate employees. The note flagged new news from Saudi Arabia:

Saudi Arabia: Seven more case of novel coronavirus reported Seven people in Al-Ahsa governate in the Eastern province have been confirmed infected with the novel coronavirus. Five have died and the other two are critically ill in intensive care. It is unclear whether there are any links between these cases or whether they are “sporadic” infections. Overall the risk to travellers remains low.

This was odd. You’ll remember the new coronavirus, distantly related to SARS, which surfaced last year in a slow and not well-disclosed manner (for the back story, see these posts from last September, October, November and December). Since the initial reveal last year, there has been very little information released about the virus and whatever illness it might be causing. The World Health Organization has been monitoring the gradual accumulation of cases, but there has been almost nothing published since last fall. In fact, though teams from Columbia University and the Centers for Disease Control and Prevention have been to the Kingdom of Saudi Arabia to help investigate the new illness, neither entity has published anything since those trips were made. And at the point at which I opened my inbox this morning, the WHO’s last update on the new virus had been published on March 26.*

Meanwhile, of course, the infectious disease world has been riveted by the rapid emergence in China of a different virus, the new avian flu H7N9, and many questions have been aimed at whether the Chinese government, which attempted to conceal the emergence of SARS 10 years ago, has learned the lesson of transparency. (I talked about that history, and how the world found out about SARS, in this segment from On the Media a few weeks ago.)

Almost since H7N9 emerged in March, though, the WHO and other bodies have been averring that China is actually doing a good job this time around. And with this overnight news from Saudi, it seems that the questions about disease-outbreak transparency may have been directed at the wrong country.

There’s lots of news to catch up with regarding the new coronavirus that emerged last summer in the Middle East and has been causing concern to international health authorities all autumn: additional cases, additional deaths, and new lab evidence that is more than a little concerning.

Today, while the United States has been largely off-line following our Thanksgiving holiday (and while Northern Europe was on its way to the pub for Friday evening revelry), the World Health Organization announced four new cases of the novel coronavirus that caused a great deal of worry immediately before the October hajj season. (Earlier posts here and here.)

In its bulletin, released by the WHO’s Global Alert and Response team (GOAR), the agency said:

Four additional laboratory-confirmed cases have been identified; one of the four has died.

One case is in Qatar, the location of one of the original two cases earlier this year.

Three of the new cases, including the dead person, are in Saudi Arabia, site of the other original case (who also died).

Two of the three Saudi cases, including the dead person, are members of the same family.

In that family, two other people have also fallen ill, and one has died. The man who recovered showed no laboratory evidence of infection with the novel coronavirus. Analysis of the case of the person who died is continuing.

The uncertainty over the novel coronavirus that was recognized last month is captured in a research report and editorial just released this evening by the New England Journal of Medicine. (I believe these are the first peer-reviewed papers on the new organism, though it has several times been written up in the European CDC’s bulletin, EuroSurveillance.) The papers are a treatment report and analysis of the first known case, the 60-year-old Saudi man who died in June, and an examination of the larger issues raised by this case and the second known one, which occurred in Qatar and London in September.

Short summary of the situation from the second paper, co-authored by the former chief of the division of viral diseases at the US CDC:

Since there has been no evidence of human-to-human transmission or virus transmission to healthcare workers, [the novel virus] is not currently a public health risk. (NEJM Anderson 2012)

On Feb. 21, 2003, a 65-year-old physician who lived in the Chinese province that abuts Hong Kong crossed into the territory surrounding the city and checked into a hotel in Kowloon. He was given a room on the ninth floor. Sometime during his stay — no one has ever fully traced his path — he encountered roughly a dozen other people; most of them were hotel guests whose rooms were on the same floor, but some were staying on other floors, and some were visitors to events there. The physician had been sick for a week with symptoms that had started like the flu, but were turning into pneumonia, and the next day, he checked out of the hotel and went to a Hong Kong hospital. Before the end of the day, he died.

In the next few days, the people who had crossed paths with the physician left the hotel. Most of them were visitors to the special administrative region: Hong Kong is not only a port and transit hub, but a business and shopping destination for much of the Pacific Rim. They went to Vietnam, Singapore, Canada, and Ireland. As they traveled, some of them started to feel as though they had picked up the flu.